Title |
Pretransplant IgA-Anti-Beta 2 Glycoprotein I Antibodies As a Predictor of Early Graft Thrombosis after Renal Transplantation in the Clinical Practice: A Multicenter and Prospective Study
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Published in |
Frontiers in immunology, March 2018
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DOI | 10.3389/fimmu.2018.00468 |
Pubmed ID | |
Authors |
Jose M. Morales, Manuel Serrano, Jose Angel Martinez-Flores, Fracisco Javier Gainza, Roberto Marcen, Manuel Arias, Fernando Escuin, Dolores Pérez, Amado Andres, Miguel Angel Martínez, Naroa Maruri, Eva Alvarez, José Luis Castañer, Marcos López-Hoyos, Antonio Serrano |
Abstract |
Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study. Multicenter prospective observational cohort study. Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years. Early graft loss and graft loss by thrombosis. The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients. At transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2%p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4%p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17-60.27,p < 0.001). Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 (60.4 vs. 76.8%,p < 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%,p = 0.005). Patients were obtained during a 3-year period (1 January 2000-31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high. In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication. |
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Spain | 3 | 60% |
Switzerland | 1 | 20% |
Unknown | 1 | 20% |
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Practitioners (doctors, other healthcare professionals) | 1 | 20% |
Mendeley readers
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Unknown | 26 | 100% |
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Librarian | 2 | 8% |
Student > Master | 2 | 8% |
Student > Postgraduate | 2 | 8% |
Researcher | 2 | 8% |
Student > Ph. D. Student | 1 | 4% |
Other | 3 | 12% |
Unknown | 14 | 54% |
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Pharmacology, Toxicology and Pharmaceutical Science | 1 | 4% |
Social Sciences | 1 | 4% |
Nursing and Health Professions | 1 | 4% |
Other | 0 | 0% |
Unknown | 13 | 50% |